When could chest pain be a heart attack?
You are trekking up a mountain when you suddenly have pressure in the center of your chest, with accompanying shortness of breath and sweating. You have no pain in your arm or jaw. What is the next best step?
(A) Wait 30 minutes and reassess your pain
(B) Take ibuprofen
(C) Disregard the pain, as it is unlikely from a serious cause
(D) Take aspirin, and seek immediate medical attention
The patient described in the question is having a heart attack ("myocardial infarction").
Chest pain is a medical emergency and it is often difficult to distinguish between benign causes of chest pain, such as a muscle strain, and more severe causes, such as a heart attack. Deadly causes of chest pain include myocardial infarction (heart attack), pulmonary embolism (blood clot in the lung), pneumothorax (collapsed lung), cardiac tamponade (fluid around the heart), aortic dissection (tear in the large blood vessel in the chest), and more.
Whenever in doubt, it is best to treat chest pain as a medical emergency. Consider taking aspirin by mouth (325 mg) and seek immediate medical attention. Aspirin has been shown to improve outcomes in patients having a heart attack.
Why are the other answers incorrect?
A) Wait 30 minutes and reassess your pain
If a heart attack or other emergency is occurring, time is of the essence. Waiting could make the problem worse.
B) Take ibuprofen
Ibuprofen is an appropriate treatment for minor musculoskeletal pains. However, the pain described in the question is concerning for an emergency cause.
C) Disregard the pain, as it is unlikely from a serious cause
The pain described in the question has features that suggest a cardiac cause. Chest pain with the following factors is more likely to be caused by a heart attack:
- Patient over 45 years old
- History of heart or lung problems (prior heart attack, stroke, cardiac stents)
- Chest pain that worsens with exertion
- Chest pain that radiates to the shoulders, jaw or arm
- Shortness of breath
- Sweating
- Nausea or vomiting
- Chest pain after trauma or injury
However, even if all of these factors are absent, chest pain can still be due to a heart attack or other serious cause! For example, in the question above, the patient did not have radiation of the pain to the arm or jaw, but was still having a heart attack. It is a common misconception that these features can rule-in or rule-out a serious cause of chest pain.
For this reason, chest pain should be considered a medical emergency.
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